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Home > Debunking Myths About Epidural Steroid Injections (ESIs) in the Lumbar Spine

Debunking Myths About Epidural Steroid Injections (ESIs) in the Lumbar Spine

Mark W. McFarland, DOMark W. McFarland, DO

As a busy orthopedic Spine specialist, I am happy to answer the questions I get from patients before having a lumbar epidural steroid injection.  However, I’m frequently astounded by the myths and misinformation surrounding the subject.  As a result, I thought I would address some of the more common “old wives’ tales” and give you the information you need to know before the procedure.

Epidural Steroid Injections: Myth vs. Fact

Myth #1: The injection will be exactly the same as the one they give ladies when they are having a baby at the hospital – you know, an epidural.

Nope.  These injections are completely different in almost every way.

The epidural block a lady gets before having a baby is a form of regional anesthesia that will render her numb from the waist down and usually makes her incapable of walking.  This is so she won’t feel pain during the last stages of labor or during a cesarean procedure delivery. The medications used are typically a numbing medication combined with an opioid and instead of a quick shot, a catheter is placed in the intrathecal space to deliver pain-relief until delivery of the baby.  It could remain in place for hours before removal.

The lumbar epidural steroid injection contains a steroid and a fast-acting, but mild numbing medication.  It doesn’t make the patient incapable of walking or totally numb below the waist. The patient may feel some numbness down the leg(s) but this is temporary and will not prevent the patient from walking.  The injection procedure may take about five-ten minutes to complete.

Myth 2# – The lumbar steroid injection is so risky, that chances are high I could be paralyzed, become incontinent and have to wear a diaper afterward.

Here’s the good news…I’ve performed thousands of these injection procedures during my time in practice.  To date, not a single patient has been paralyzed or forced to wear a diaper due to incontinence issues arising from their lumbar epidural steroid injection.

There are risks of which to be aware – infection, dural puncture, or nerve damage are the most common. However, with sterile procedure techniques performed under fluoroscopy (live x-ray) guidance, the risks are quite minimal.

Myth #3 – These injections don’t work. My uncle had one and it didn’t do a thing to help his pain.  It won’t help me either.

Well, your uncle or you may be one of the small percentage of individuals for whom a lumbar epidural steroid injection won’t work.  But, for the majority of patients who get them, they report at least some pain relief for a few weeks or months.  Some patients report significant pain relief for up to a year.  A small percentage will report total pain relief.  I would much rather recommend an injection to my patients to see if they will experience pain relief vs. recommending a surgery without having tried the injection.  Insurance companies will typically not approve surgery unless epidural steroid injections have been tried at least once, without other compelling medical reasons to do so or contraindications.

Myth #4 – I need to be “knocked out” to have a lumbar epidural steroid injection, because it is so painful.  I had one before, and they gave me medication in an IV so I wouldn’t feel anything.  Why won’t you do that?

At OSC, we have made the decision to not administer IV sedation for lumbar epidural steroid injections, because it adds extra cost to the procedure, requires more staff, causes the procedure to take much longer and presents more risk to the patient.

Having IV sedation is also a big hassle for the patient as they are required to be NPO – nothing to eat or drink, for at least 8 hours before being sedated. This is for safety reasons so that you don’t regurgitate stomach contents while sedated, possibly causing choking, aspiration pneumonia or other complications. Procedures can be cancelled over chewing gum, sucking on a mint or cough drop, or you forgetting and taking a swig of coffee or water.

We perform these lumbar ESIs using a local anesthetic, much like you would get in the dentist’s office before the actual epidural steroid injection.  Patients typically find the initial needle stick and the numbing medication to sting, but that is over in a few seconds.  The sensation during the injection of the contrast agent (if used) and the steroid medication typically is one of pressure or nerve tingling.  Again, those sensations might be momentarily uncomfortable, but do not require IV sedation for pain relief.

 

 

 

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